Evaluation of the quality of colonoscopies performed by Alberta North Zone surgeons, family physicians and internists: a quality improvement initiative

Abstract

In Canada, more than 1 million endoscopic procedures are performed annually, 1 primarily by gastroenterolo gists and surgeons, 1,2 but also by some internists and family physicians. 1,3,4 Nongastroenterologists perform most of the endoscopic evaluations in rural and smaller urban Canadian communities. 1,2,5 Variability exists between individual endoscopists' colon oscopy performance, which may affect future rates of colorectal cancer 6,7 or adverse events. 8 Some Canadian stud ies report that polyp detection may be lower 9 and future cancer rates may be higher when colonoscopies are per formed by non gastroenterologists. [10][11][12] Other studies show that nongastroenterologists perform colonoscopies that exceed quality standards. 3,4 We performed the Alberta North Zone Endoscopy Quality study to determine whether a diverse group of ruralbased nongastroenterologist endoscopists within a large health region are achieving key performance indicator (KPI) bench marks in colonoscopy, including cecal intubation, polyp detec tion, bowel preparation, patient comfort and withdrawal times. MethodsThis quality improvement initiative was a prospective cohort study exploring KPIs on colonoscopies performed by volun tarily participating Alberta North Zone colonoscopists. Data were collected on consecutive colonoscopies performed from study commencement (June 2018 -with asynchronous par ticipant and community starts) until March 2020, when non urgent endoscopies were temporarily halted owing to the COVID19 pandemic. Interim results have been presented